Children's understanding of illness: developmental aspects

Acutely and critically ill children, like adults, want information about their illness. Children put information they gather into the context of their understanding of the world around them, which is influenced by their level of cognitive development. The development of their understanding of the world is also apparent in their understanding of their bodies and of illness etiology, prevention, and cure. Research generally supports the expected developmental progression of children's understanding of body parts and functions and of illness etiology. Implications for practice are provided.

Neonatal and pediatric critical care: a call for collaboration

Neonatal and pediatric critical care units are growing in size and complexity. Each unit is staffed by a highly specialized group of nurses. Although the units share many commonalities, the relationship between nurses in the neonatal and pediatric critical care units often is characterized by rivalry and antagonism rather than by cooperation. The purpose of this report is to identify similarities and differences between the two units and to describe the benefits of collaboration between units.

Maternal employment effects on families and preterm infants at 18 months

The purposes of this study were to investigate the effects of maternal employment, maternal employment attitude/behavior consistency, and degree of choice and satisfaction with the employment decision on family functioning and preterm infant development and to describe changes in family functioning over time. Data were collected in the family's home (N = 79) when the infant was 3, 9, and 18 months old. Parents in nonemployed-mother families were more satisfied with their families at 18 months than parents in employed-mother families. Decreases in family cohesion and/or adaptability from 9 to 18 months were seen for fathers in employed-mother families, for mothers in nonemployed-mother families, and for mothers in families where the mother's employment attitudes and behaviors were consistent. Degree of choice was positively related to the child's mental development, mother's perception of family cohesion, and mother's and father's satisfaction with family.

Single-item indicators in nursing research

Single-item indicators that ask respondents for their global rating of a specific concept are congruent with nursing's emphasis on wholism and individualism. They allow the subject to take personally salient features of the situation into account when providing a response. The psychometric performance of single-item indicators in published research and in a sample data set using measures of the mother's choice and satisfaction with her employment decision support the validity and reliability of the measures, suggesting that these indicators deserve more attention in nursing research. Recommendations for the use of single-item indicators are provided.

A comparison of pulmonary artery, rectal, and tympanic membrane temperature measurement in the ICU

OBJECTIVE

To compare tympanic membrane temperature with pulmonary artery (PA) and rectal temperature (calibrated glass mercury) to determine consistency among measures.

DESIGN

Convenience, within-subject, quasi-experimental.

SETTING

Midwestern university-affiliated tertiary medical center.

PATIENTS

128 adult (18 years or older) patients admitted to the surgical intensive care unit with an age range of 18 to 90 years (mean 57 years).

OUTCOME MEASURES

Tympanic, PA, and rectal temperature.

INTERVENTION

Rectal and tympanic membrane temperatures were measured in 60 patients. PA and tympanic membrane temperatures were measured in 68 patients.

RESULTS

Rectal and tympanic membrane temperatures were moderately correlated (r = 0.525). Mean rectal was slightly higher than mean tympanic membrane temperature (mean difference 0.19 degrees C). PA and tympanic membrane temperatures were highly correlated (r = 0.909). Mean tympanic membrane temperature was slightly higher than mean PA temperature (mean difference 0.42 degrees C). For PA temperatures, 57 (84%) of the differences were between 0 and +1 degree Celsius, whereas for rectal temperature, 23 (37%) were between 0 and +1 degree Celsius and 28 (47%) were between 0 and -1 degree Celsius.

CONCLUSIONS

Tympanic temperature measurements would be an appropriate substitute for PA temperature if the PA catheter has been removed or the PA thermistor is nonfunctional. In addition, this study suggests that to effectively track temperature in a particular patient, the site for temperature measurement must be consistent.

Maternal employment, family functioning, and preterm infant development at 9 and 12 months

The purpose of this study was to investigate the effects of maternal employment on child development and family functioning for families with preterm infants. Data were collected in the family's home (N = 67) when the infant was 3, 9, and 12 months of age. Maternal employment at 3 months had little effect on 9- and 12-month child mental or psychomotor development or on family cohesion, adaptability, or satisfaction. Maternal employment attitude/behavior consistency was a significant predictor of psychomotor development. Choice in the employment decision at 3 months was positively related to both mental and psychomotor development at 9 and 12 months for nonemployed mothers.

Child and family reactions during and after pediatric ICU hospitalization: a pilot study

OBJECTIVE

To describe child behaviors and level of family functioning after discharge from the pediatric ICU (PICU) and to begin to explore the relationship of family reactions and the child's severity of illness to child and family outcomes after discharge.

DESIGN

Exploratory, repeated measures: Time 1 (T1) at 24 hours after admission; Time 2 (T2) at 2 to 4 weeks after hospital discharge.

SUBJECTS

Nine mothers and fathers of children who were 5 years of age or younger, hospitalized in a PICU for at least 1 day, expected to survive.

MAIN STUDY MEASURES

Parental Concern Scale and Parental Stressor Scale: PICU at T1; Posthospitalization Behavior Questionnaire at T2; Feetham Family Functioning Survey and FACES III, at both T1 and T2; and Pediatric Risk of Mortality to measure illness severity.

RESULTS

Mothers' cohesion scores decreased significantly from T1 to T2. Scores from the Pediatric Risk of Mortality were not related to family measures. Mothers' family cohesion and satisfaction with family after discharge were negatively related to time the child was intubated. Few family measures were related to the Parental Concern Scale and Parental Stressor Scale: PICU subscales.

CONCLUSIONS

PICU admission of a child is a stressful event for parents, independent of the child's illness severity. Mothers' perceptions of family may be negatively affected.

Characteristics of a child's critical illness and parents' reactions: preliminary report of a pilot study

OBJECTIVE

To explore the relationships between parents' reactions to the pediatric intensive care unit admission of a child and characteristics of the child's illness.

METHOD

A convenience sample, consisting of 16 mothers and 13 fathers of 16 children aged 5 years and younger, was used. The Pediatric Risk of Mortality scale was used to measure severity of illness. Parental reactions were measured at about 24 hours after the child's admission with the Parental Stressor Scale: PICU and the Parental Concerns Scale.

RESULTS

Mothers' concerns and stressors were not related to the child's Pediatric Risk of Mortality score. However, fathers reported greater concern about the child's experience and about parenting as the child's Pediatric Risk of Mortality score increased.

CONCLUSIONS

Parents' reactions to their child's critical illness and admission to the pediatric intensive care unit were not related to characteristics of the child's condition in this small sample. Future research needs are suggested.

Characteristics of a child's critical illness and parents' reactions: preliminary report of a pilot study

OBJECTIVE: To explore the relationships between parents' reactions to the pediatric intensive care unit admission of a child and characteristics of the child's illness. METHOD: A convenience sample, consisting of 16 mothers and 13 fathers of 16 children aged 5 years and younger, was used. The Pediatric Risk of Mortality scale was used to measure severity of illness. Parental reactions were measured at about 24 hours after the child's admission with the Parental Stressor Scale: PICU and the Parental Concerns Scale. RESULTS: Mothers' concerns and stressors were not related to the child's Pediatric Risk of Mortality score. However, fathers reported greater concern about the child's experience and about parenting as the child's Pediatric Risk of Mortality score increased. CONCLUSIONS: Parents' reactions to their child's critical illness and admission to the pediatric intensive care unit were not related to characteristics of the child's condition in this small sample. Future research needs are suggested.

Maternal employment effects on family and preterm infants at three months

The purpose of this study was to investigate the effects of maternal employment status and the mother's degree of choice and satisfaction regarding her employment status on family functioning and on the preterm infant's development at three months chronologic age. Families with preterm infants (N = 110) were categorized as employed, nonemployed, and on leave of absence based on the mother's employment status at three months postpartum. There were no significant differences across employment groups on family functioning and child development. The infant's motor development was positively correlated with number of hours employed per week and degree of choice for the employed mother families, but negatively correlated with choice for the nonemployed mother families. These results suggest that maternal employment may not be detrimental for infants born prior to term. Indeed, it may be beneficial, especially if the mother has a choice in the matter.

Parent stress associated with pediatric critical care nursing: linking research and practice

This paper connects research findings to nursing practices that may be helpful when working with stressed parents of critically ill children. Theories and concepts foundational to understanding parental stress related to pediatric critical care are reviewed. Research findings particularly associated with parent role stress are introduced, and suggestions for using these findings to design nursing interventions are presented.

Emergent admission to the pediatric intensive care unit: parental concerns

To identify parental concerns when a child is suddenly admitted to the pediatric intensive care unit, 17 parents of ten critically ill children were interviewed using a structured format between 20 and 36 hours after admission about their concerns around the time of admission and at the time of interview using the Parental Concerns Scale. The individual concern items receiving the highest ratings were the child's survival, the possibility of mental or physical impairment, the child's diagnosis, and the amount of pain experienced by the child. Total concern scores decreased over time for both mothers and fathers when the child's prognosis was good and, for mothers only, when the child had an infectious illness rather than accidental injuries. Implications for nursing practice are discussed.

Factors related to maternal employment status following the premature birth of an infant

A sample of 110 two-parent families whose preterm infants were less than 37 weeks gestation, appropriate for gestational age, and free of major congenital anomalies were recruited from two level-III intensive care nurseries. At 3 months postpartum, 40 mothers (36.4%) were employed, 15 (13.6%) stated they were on a leave of absence, and the remaining 55 mothers (50%) were not employed. Although not significantly different on demographic or infant morbidity variables, employed mothers were significantly more employment-oriented and reported less choice and satisfaction with employment status than nonemployed mothers. In addition, employed mothers were employed more hours prenatally and reported prenatal plans to be employed sooner after the infant's birth than nonemployed mothers. Employed mothers also perceived more support from others for their employment and greater financial necessity and availability of child care than nonemployed mothers. Higher scores on employment orientation were correlated with higher maternal education level, fewer children, more hours employed, higher total support for their employment, higher financial necessity, and less choice and satisfaction with employment status.

Data management issues in longitudinal research

Much of the existing literature about the research process has neglected data management. While design, instrumentation, sampling, and analysis are important parts of the process, paying attention to the issues surrounding data management is crucial to the success of the study. Data entry and analysis are facilitated when the details of data structure and management are decided before data collection begins.

A psychometric analysis of the Family Environment Scale

Psychometric properties of the Moos (1979) Family Environment Scale (FES) were studied in a sample of 73 two-parent and 19 single-parent families. Mothers and fathers completed the FES questionnaire while the child in the family closest to 11 years old was administered the FES in an interview. Moos reported initial internal consistency estimates (Kuder-Richardson 20s) between .64 and .79. In this study, KR20s ranged from .24 to .75 for the entire sample, and differences among mothers, fathers, and children in the KR20s calculated for each group were found. Although Moos hypothesized three dimensions into which the 10 subscales fall, confirmatory factor analysis using LISREL VI did not support this assertion.